Abstract: Objective To investigate the short-term and long-term effects of autologous fat grafting (AFG) combined with platelet-rich fibrin (PRF) in the treatment of diabetic foot ulcers (DFU).Methods This study was designed as a prospective randomized controlled trial (RCT).A total of 116 patients with DFU treated in our hospital from July 2020 to December 2023 were enrolled and divided into a fat grafting group and a combined treatment group with 58 patients in each group according to the randomized numerical table method.The fat grafting group received negative pressure suction and autologous fat grafting to treat the wound,while the combined treatment group received negative pressure suction,autologous fat grafting,and PRF to treat the wound.Clinical baseline data of the two groups were collected.The 50% ulcer healing time,30-day wound healing percentage,7-day granulation tissue score,and VAS score were evaluated in both groups.Follow-up was conducted for 3 months,and the ulcer surface of the patients was scored using the Pressure Ulcer Scale for Healing (PUSH) before treatment,at 7 days,1 month,2 months,and 3 months after treatment to assess the treatment effect.Results The healing time of 50% ulcer surface in the combined treatment group was (21.44±3.86) days, which was lower than that in the fat transplantation group [(26.39±3.79) days], and the difference between the two groups was statistically significant (P<0.05). The percentage of ulcer surface healing in the combined treatment group at 30 days was (66.39±6.92) %, and the granulation tissue score at 7 days was (3.96±0.47) points, which were higher than those in the fat transplantation group [(59.87±7.44) % and (3.58±0.44) points]. There was a statistically significant difference between the two groups (P<0.05).After 7 days of treatment, the vascular endothelial growth factor in the combined treatment group and the fat transplantation group was (6.52±0.76) ng/ml and (4.96±0.63) ng/ml respectively, and the transforming growth factor beta1 was (111.37±1.54) ng/ml and (9.04±1.18) ng/ml respectively. The interleukin (IL) -1β was (84.32±11.28) pg/ml and (113.15±15.32) pg/ml respectively, and the IL-10 was (40.39±6.87) pg/ml and (59.67 ±8.54) pg/ml respectively. There was a statistically significant difference between the two groups (P<0.05).The PUSH scores of the combined treatment group at 1 month, 2 months and 3 months after treatment were (7.58±1.44) points, (6.27±1.28) points and (2.44±0.72) points respectively, while those of the fat transplantation group were (8.62±1.39) points, (7.08±1.43) points and (4.12±0.93) points respectively. There was a statistically significant difference between the two groups (P<0.001).Conclusion AFG combined with PRF shows good short-term and long-term effects in the treatment of diabetic foot ulcers.

Key words: autologous fat grafting; platelet-rich fibrin; diabetic foot; ulcer; healing